Begin Health: Dr. Nattiv we are so excited to have you with us today to help us answer common questions that we hear in our Begin Health community and to help parents demystify the role of pediatric gastroenterologists.
At Begin Health we are committed to bringing forward evidence-based education and answers for our parent community as they navigate their kids’ health and importantly bring more guidance related to the topic of the developing gut microbiome and what this means for kids’ digestive health.
To get us started, we’d love to hear more about you and what brought you to pediatric gastroenterology.
Dr. Nattiv: Absolutely! As is the case with most physicians, my journey in medicine was very much influenced by my patients. While in medical school, I was caring for a young girl with abdominal pain and weight loss. . The diagnosis was a difficult one but ultimately she was diagnosed with Crohn’s disease. Once we were able to narrow down her diagnosis and start her on treatment she turned around very quickly. I was amazed at her resilience and the ability for her gut to heal so quickly. This was really the beginning of my fascination with intestinal development and regeneration following injury. I moved to University of California in San Francisco and completed a fellowship in pediatric gastroenterology. I became very involved in intestinal stem cell research. Did you know that our intestines are lined with ‘adult stem cells' that are responsible for replacing its lining every 3-5 days? It's really fascinating to watch… My research was specifically focused on discovering mechanisms and factors that may hasten intestinal regeneration following injury.
Begin Health: What is the biggest change you have seen over the course of your career in Pediatric Gastroenterologist that you are most surprised by or has been the biggest change?
Dr. Nattiv: That is a great question! I guess one thing that has really surprised me is how much more informed parents and patients have become over the past 10-20 years. Parents are coming to office consultations very often having done their ‘homework’. They have read medical literature online or have connected with other parents on social media to learn from experiences of others. Parents are increasingly aware of the medical therapies that are available to their children and potential pitfalls. I think this is great! For one - it keeps us doctors on our toes! Haha… but also the idea of a shared medical decision making process between parents and physicians almost always leads to better outcomes.
Begin Health: What questions do you advise parents ask their health care practitioners or tests they should ask to have run if they are preparing for a visit with their pediatric gastroenterologist?
Dr. Nattiv: That’s a great question. So many times, pediatricians and parents want to be proactive and obtain lab testing prior to visiting the pediatric specialist or gastroenterologist. It can be difficult to predict which tests the specialist is going to order. However, in cases of chronic constipation in which the child has suffered other symptoms including chronic abdominal pain, vomiting or difficulty gaining weight - it can be helpful when certain systemic illnesses have already been ruled out. Specifically, pediatricians should screen for electrolyte abnormalities (standard chemistry) thyroid disease (TSH), celiac disease (TTG/DGP IgA and Total IgA) and lead poisoning (when relevant - not many people have lead paint in their houses
Begin Health: Kids are experiencing discomfort, irritability, straining and pain during pooping. Parents talk about their kids’ not pooping for days, and sometimes weeks. When should a parent see a doctor or specialist? When should a family seek emergency care?
Dr. Nattiv: You’re correct constipation is quite common and parents should know that they are not alone in this struggle. Constipation is defined as hard or infrequent stooling. Generally speaking - kids should poop at least once a day and stools should be soft - consistency of soft serve ice cream (think Poop Emoji). If kids are pooping every other day then parents should start introducing more fiber rich foods and/or improve child's hydration (water is best). Goal of fiber and hydration depends on age and is totally Google’able information.
If kids are pooping less frequently than every other day for more than 3-4 weeks, then it's probably time to discuss with the pediatrician. Finally, occasionally, constipation is rarely a result of some other underlying illness such as a genetic illness (eg. cystic fibrosis, Hirschprung’s disease), a hormone issue (eg. thyroid disease) or food allergy/intolerance (eg. celiac disease) or problem with nerves or muscles of the lower anus or lower intestines. These children usually have additional symptoms such as abdominal pain, rectal bleeding or poor weight gain and also need to see a doctor, as soon as possible.
Summary Generally, kids should poop at least once a day and stool consistency should be soft, like soft serve ice cream. If your child is suffering from constipation or withholding, it can be helpful to rule out other systemic illnesses with the support of a Pediatric Gastroenterologist.
Dr. Roy Nattiv is a Pediatric
Gastroenterologist located in Los Angeles,
California. He is board-certified with
expertise in abdominal pain, diarrhea,
constipation, food allergies, celiac, IBD and
IBS, hepatology and nutrition in children.